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Nebraska rates for HCPCS L0650

Lumbar-sacral orthosis (LSO), sagittal-coronal control, with rigid anterior and posterior frame/panel(s), posterior extends from sacrococcygeal junction to T-9 vertebra, lateral strength provided by rigid lateral frame/panel(s), produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$657.41 / $657.41 / $657.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$657.41 / $1,500.00 / $2,672.67
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,530.00 / $1,530.00 / $1,744.85
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$769.70 / $846.66 / $855.22
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $952.31 / $1,279.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $1,276.41 / $2,422.19
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$591.66 / $1,128.39 / $3,899.19
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$444.95 / $712.41 / $1,187.34
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,279.55 / $1,285.69 / $1,979.14
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,285.69 / $1,592.89 / $2,690.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$444.95 / $712.41 / $988.78